Healthcare Provider Details

I. General information

NPI: 1457636821
Provider Name (Legal Business Name): JENNIFER DEMOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 EISENHOWER DR SUITE 1200
SAVANNAH GA
31406-1600
US

IV. Provider business mailing address

210 E DERENNE AVE
SAVANNAH GA
31405-6736
US

V. Phone/Fax

Practice location:
  • Phone: 912-443-4200
  • Fax: 912-355-8124
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN096491
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: